HomeMy WebLinkAbout04-0093Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
stat of ' crv ,J.
also known as
, Deceased
Social Security No.
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the executo¢~l~ named-in the Last Will of [he
[~ Decedent, dated ~/~1/._ 2-3. ]~[~1 and codicil(s) dated
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution df the documents offered
for probate; was not the victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse
any) and heirs:
Name Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional =;heets if necessary.
Decedent was domiciled at death in 6b~t~J~..~z_~J~'D County,.~PennsWvania, with his/her ~ast family or pr,nc,pal
residence at ~-0"~ /')'[6~(-$ ~,l~lO~- ~.~C/JL~;~ ["'~ t'PO/"2~
Decedent. then years of age, died ,20__, at
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property .............................. $
(If not domiciled in PA) Personal property in Pennsylvania ...................... $
(If not domiciled in PA) Personal property m County .......................... $
Value of real estate in Pennsylvania ............................................... $
Total
Real Estate situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
J Typed or pnnted name and residence J
PW-7
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and
correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent,
Petitioner(s) will well and truly administer the estate/~ccor~g to I~,~-) (,~x/ ~
DECREE OF REGISTER
Estate of
also known as
Deceased No.
Social Security No: ~ l- I~- I,_~___.~ ~ Date of Death: !-~.!- O ~
AND NOW, ,- \p,t-,~.,~ ~o 20o~L , in consideration of the Petition
on the reverse side he~eon, satisfactory proof having been presented before me,
IT IS DECREED that Letters [~"'¢estamentary [] of'Administration
are hereby granted to ~ ~ %Tou~.~.J~. ~.,-,4 ~.-r.,~L,n-c ~. .~.~.~
in the above estate and that the instrument(s), if any, dated
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ........................... $
Short Certificate(s)...?. .... $
Renunciation .................. $
Affidavit ( ) ................. $
Extra Pages ( ) ............ $
Codicil .......................... $
JCP Fee ........................ $
Inventory & Tax Forms... $
Other ............................ $
TOTAL ................ $ ~/~'o ~:2 ~
RW-7a
Attorney:
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
)
COUNTY OF CUMBERLAND )
SS.
I, J. Robert Stauffer, the witness whose name is signed to the attached or
foregoing instrument, being duly qualified according to law, do depose and say that I was
present and saw Testator sign and execute the instrument as her Last Will and Testament,
that BETTY J. STOVER signed willingly and that she executed it as her free and
voluntary act for the purposes therein expressed; that I, in the hearing and sight of the
Testator signed the Will as witness; and that to the best of my knowledge the Testator
was at the time 18 or more years of age, of sound mind and under no constraint or undue
influence.
2004.
Sworn or affirmed to and subscribed to before me by
witness, this o~2 ~ day ofq.~ ri IA tt rc,I
My Commission expires:
Notary Public
COMMONWEALTH OF PENNS,LVANIA
· Heidl M. Nelson, Nolary Public
~ 8op, Cum~a.d Co~nt~
-,,x ,..~-m~.~n Expires June 27, 2007
REGISTER OF WILLS OF (~o~e~t._a~.,~ COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(~m~h-) a subscriber hereto, (zac~.) being duly qualified according to law, depose(s) and say(s) that
/-/~ /3 far~iiiar With' t~he signatUre of
testat o~ of (~z:z~f the s'2bscr,.'bing ;v.it.-_~sez ~) the will presented herewith and
ced'~ci!
that /7-~ believes the signature on the will is in the handwriting of
to the best of. J-J! 3 knowledge and belief.
Sworn to or affirmed and subscribed before -~Jt~25
me this day of (Name_j
(Address)
Register
(Name)
(Address)
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9990647
No.
Local Registrar
JAN 2 2 200
Date
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
~(t,,e~d u,~.,vt,~ u.o~.,~ ~ ............... ~ f ~ "L- 1/21/2004
,~,.,~..,,,.,~,,,~,,~,.,,.~ .... ,,..~.o~,., i,, I,,. 12 ' I .... I,Ja~.c~,,e~ J,,. _
203 Me~'ls Dr'ire ~-n,~ ...m,. ~, .,...liit ,,v "',.~ ,,.d ,. South M'idd'le'bon
,L Carlisle, PA 17013
,,. Ernest L. Bowers
~ John A. Stover, Jr.
Cumberland
1/24/2004
FD 012633 L
J,,. Catherine J. Calaman
J,~12~ ~ordc~Y, Mec~%nicsburg, PA 170.50
J2,.~enterville M~norial Park J,,d Newville, PA 17241
Im~w. lng Brothers Puneral Hcme, Inc., Carlisle, PA
D 2ZL. 5'
LAST WILL AND TESTAMENT OF BETTY J. STOVER
I, BETTY J. STOVER, of the Township of Monroe, County
of Cumberland and State of Pennsylvania, being of sound and dis-
posing mind, memory and understanding, do make, publish and de-
clare this my Last Will and Testament.
I direct the payment of all my just debts and funeral
expenses as soon after my decease as the same can be conveniently
done.
o
I give, devise and bequeath all the rest, residue and
remainder of my estate, of whatsoever nature and wheresoever
the same may be situated, to my husband, John A. Stover, Sr.,
absolutely and unconditionally.
In the event that my husband, John A. Stover, Sr., should
predecease me, or should he die at about the same time as I do,
such as in an accident common to both of us, then in such event,
I give, devise and bequeath my entire estate, real, personal
and mixed, whatsoever and wheresoever the same may be situated,
to my two children, to wit, John A. Stover, Jr., and Catherine J.
Schorr, share and share alike, per stirpes.
LASTLY, I nominate, constitute and appoint my husband, John
A. Stover, Sr., Executor of this my Last Will and Testament, and
in the event that my said husband should predecease me, or should
he be unable to serve in such capacity for any reason, then in such
event, I nominate, constitute and appoint my children, to wit,
-1-
John A. Stover, Jr., and Catherine J. Schorr, Co-Executors
of this my Last Will and Testament, in his place and stead.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this ~ ~ day of ~.~i'~c~_~ A.D. 1981.
' J. Stover
(SEAL)
Signed, sealed, published and declared by the above named,
Betty J. Stover, as and for her Last Will and Testament, in
the presence of us, who have subscribed our names hereto as
witnesses, at the request of said testatrix, in her presence
and in the presence of each other.
-2-
CERTIFICATION OF NOTICE
UNDER RULE 5.6(a)
WillNo: Zoo~t- (74)Q~ AdminNo:
To the Register:
I certify that notice of estate administration required by Rule 5.6(a) of the Orphans'
Court Rules v,,~ s~-vved on or mailed to thc following beneficiaries of the above-captioned
estate on 2 ~ c/~ 0 ~ :
Name Address
Notice has now been given to all persons entities thereto under Rule 5.6(a) except:
(Signature)
Telephone (7~7)
Capacity:
Personal Representative
Counsel for Personal
Representative
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIDDLE iNITIAL)
Stover, Betty J
D~AT--~ Of DEATH (MM43D-YEAR) 7 DA~E 6F BIRTH (MM-DO:Y~ARi
01/21/2004 i 05/31/1926
F APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE ~NIT~AL)
OFFICIAL USE ONLY
FILE NUMBER
21 04 0093
201-18-1532
THIS RETURN MUST SE FILED iN BUPLICATE WITH THS
REGISTER OF WILLS
SCClAL SECURITY NUMBER
[] 1. Original Return [] ~. "Supplemental Fi~rrt [~ 3. Remainder Return (date of d~ath prior to 42-13-82)
[] 4. LimitadEstate [] 4a. FuturelnterestC°mPr°mise(date°fdeathaser [] 5. Federal Estate Tax Return Required
12-12-82)
[] 6. Decedent Died Testate (Attachcopy [] 7 Decedent Maintained a Living Trust (AItach 8. Total Number of Safe Deposit Boxes
of Will) copy of Trust)
< [] 9. Litigation Prcceeds Received [] 10. Spousal Poverty Credit (date of death belween [] 11.Election to tax under Sec. 9113(A) (Attach Sch O)
Thomas J. Ahrens '
'~' ~ ~IRM~b~ (If applicable) 5521 Carlisle Pike
~,~ Ahrens Law Offices, P.C. Mechanicsburg, PA 17055
717/697-1800
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Modgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
[] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probata Properly
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Modgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(1) Nor~!
(2) 2,400.2~L
(3) Non~
(4) Non;e'
(5) 13,971.7~'
(6) Non*x?
(7) None
(9) 10,021.37
(10) 1,475.75
(8) 16,371.99
(11) 11,497.12
12. Net Value of Estate (Line 8 minus Line 11) (12) 4,8 7 4.8 7
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 4,8?4,8?
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, x ,00 (15)
or transfers under Sec. 9116(a)(1.2) -
16.AmountofLine14taxableatlinealrate 4,874.87 x .045 (16) 219.37
17.Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
x .12 (17)
x .15 (18)
(19)
219.37
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-IS00 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
C1TY
203 Meals Drive
Carlisle
iSTATE PA !ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line lg)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C)
(1) 219.37
0.00
(2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 1 Line 20 to request a refund
5. If Line l + Line 3 is greater than Line 2, enterthedifference. This is the TAX OUE. (5) _ 219,37
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 219.3 7
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yea No
a. retain the use or income of the property transferred; ..................................................................................
b. retain the right to designate who shall use the property transferred or its income; ....................................
d. receive the promise for life of either payments, benefits or care? ..............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ....................................................................................................................... []
3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ......... []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................................................................................................................... []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
J n. vet . 6126, Wall[ngford Wa'/
NATURE OF ¢~EF~SON RESPONSIBLE FOR lNG RETURN ADDRESS DATE
f~a~:~YSch°rr 7'~ 0228 Blue Bird Avenue
l/~~'~ ~NX^T,VE Harrisburg, PA 17112 (~'
SIGNATURE OF PREPARER ~;~HE ADDRESS 552 1 Carlisle Pike DATE
Thom~.A?a.~..___ ~ . .... Mechanicsburg, PA 17055 ? -O0-' Dy
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. {9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. {9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. {}9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. {9116
1.2) [72 P.S. {9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}9116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Stovar, Betty J
FILE NUMBER
21 - 04 - 0093
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
44 Shares of PNC Financial Common Stock
UNITVALUE IVALUE
AT DATE OF
DEATH
54.55 2,400.20
TOTAL (Also enter on line 2, Recapitulation) 2,400.20
ESTATE OF
Stover, Betty J
SCHEDULE E
CASH, BANK DEPOSITS,& MISC.
PERSONAL PROPERTY
FILE NUMBER
21 - 04 - 0093
nc ude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedu · F.
ITEM
NUMBER
1
2
3
4
5
6
7
8
9
DESCRIPTION
PNC Checking Account # 5070027594
1989 Royal Cove Trailer S/N 1311-0730Y (bill of sale attached)
1978 Chevrolet Cavalier
Contents of trailer sold to Potteiger Auction Services
2003 Federal Income tax refund
Aero Oil refund
Trailer Insurance refund
Vehicle Registration refund
PNC Stock dividend
VALUE AT DATE Of
DEATH
4,569.15
8,000.00
500.00
350.00
240.00
36.64
218.00
36.00
22.00
TOTAL (Also enter on Line 5, Recapitulation) 13,971.79
ESTATE OF
Stovcr, Betty J
SCI-EE3ULE H
~~&
~TNE COSTS
F LE NUMBER
I 2!- 04- 0093
Debts of decedent must be reported on Schedule I.
ITEM FU DESCRIPTION
NUMBER
A. NERAL EXPENSES:
Ewing Brothers Funeral Home, Inc.
2 Funeral luncheon
3
4
5
Clergy
Headstone engraving
Social Secudty Number(s) / EIN Number of Personal Representative(s):
Street Address
City State __ Zip
Year(s) Commission paid
Attorney's Fees Ahrens Law Offices, P.C.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State __ Zip
Relationship of Claimant to Decedent
Probate Fees Register of Wills
Additional Probate fee due
Accountant's Fees
Tax Rotum Preparer's Fees
Other Administrative Costs
Cumberland County Law Journal - Estate Notice
AMOUNT
7,897.50
125.00
150.00
85.00
1,500.00
43.00
32.00
75.00
The Sentinel - Estate Notice
74.75
Total of Continuation Schedule(s) 39.12
IOTAL (Also enter on line 9, Recapitulation) 10,021.37
COMMONWEAL'rH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stover, Betty J
PA Inheritance Tax filing fee
Estate checks
Postage & fees
ScheduleH
-'ILE NUMBER
21 - 04 - 0093
15.00
3.00
21.12
Page 2 of Schedule H
ESTATE OF
Stover, Betty J
Include unreimbursed medical expenses.
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS /
i FILE NUMBER
21 - 04 - 0093
ITEM
NUMBER
2
3
4
DESCRIPTION
Checks written prior to death, but cashed after death
Final PPL bill
Final Sprint bill
Final medical bills
Final Comcast bill
AMOUNT
173.38
55.86
48.36
1,192.66
5.49
TOTAL (Also enter on Line 10, Recapitulation) 1,475.75
EX+ (9-00) ~
COMMONWEALTH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stover, Betty J
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21 - 04 - 0093
[ ] RELATIONSHIP TO AMOUNT OR SHARE
NUMBER~ NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY ,~,. DECEDENT.,~ U~L'r...-~.,, ] OF ESTATE
Io TAXABLE DISTRIBUTIONS (include outright spousal distributions)
I [ John A. Stover Jr. Son 150%
6126 Wallingford Way, Mechanicsburg, PA
2 I Catherine J. Schorr Daughter 50%
6228 Blue Bird Avenue, Harrisburg, PA
II.
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENTOFREVENUE
BUREAU OFINDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-O601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV 1162 EX(11-96)
NO. CD 00436O
AHRENS THOMAS J ESQUIRE
5521 CARLISLE PIKE
MECHANICSBURG, PA 17050
........ fold
ESTATE INFORMATION: SSN: 201-18-1532
FILE NUMBER: 2104-0093
DECEDENT NAME: STOVER BETTY J
DATE OF PAYMENT: 09/09/2004
POSTMARK DATE: 09/0812004
COUNTY: CUMBERLAND
DATE OF DEATH: 01/21/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $219.37
TOTAL AMOUNT PAID:
$219.37
REMARKS:
SEAL
CHECK# 111
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
'rices, P.C.
IIIIIIIIIIIIIIIii11111
r-D
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIYTSTOH
DEPT. ZOO601
HARRTSDURG, PA 1711D-0601
COHHONgEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DZSALLONANCE
OF DEDUCT/ONS AND ASSESSMENT OF TAX
THOHAS J AHRENS
AHRENS LA~ OFFZCES
5521CARLZSLE
HECHANZCSBURG
~{ ~ETTY J
DATE 11-08-200q
ESTATE OF STOVER
DATE OF DEATH 01-21-200q
FILE NUHBER 21 0q-0095
COUNTY CUHBERLAND
ACM 101
I Amount Rem1 ~c~cad
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF gILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-15&7 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAISEMENT, ALLO#ANCE OR
DZSALLONANCE OF BEDUCTZONS AND ASSESSHENT OF TAX
ESTATE OF STOVER BETTY J FZLE NO. 21 0~-0095 ACM 101 DATE 11-08-200~
TAX RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORTGZNAL RETURN
1. Real Es~a~e (Schedule A) (1),
2. S~ocks and Bonds (Schedule B) (2)
5. Closely Held S~ock/Par:tnership Zn~eras~ (Schedule C) (5)
o,. Mortgages/No'es Receivable (Schedule D) (q)
5. Cash/Bank Dapos/~s/Misc. Personal Proper~y (Schedule E) ($)
6. Jointly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To~:al Asse~:s
APPROVE]) ])EDUCTZONS AND EXEHPTZONS:
9. Funeral Expanses/Adm. Cosmos/Misc. Expenses (Schedule H) (9)
10. Oeb~s/Nor~:gage L/ab/]*[~/es/L[ens (Schedule X) (10)
11. To~a]* Deduc~c/OhS
12. Ne~ VaZua of Tax Re~urn
Z,~O0.20
.00
15~971.79
.00
.00 NOTE: To insure proper
cred~ ~o your account,
sube/~ ~he upper portion
.00 of ~h/s fore w~h your
~ax payment.
.00
10,021.37
16,371.99
13.
lq.
NOTE:
(Zl) 11 .~97.12
(12) ~'87~"87
Charitable/Governmental Bequests; Non-elected 911:5 Trusts (Schedule J) (1:5)
Ne~: Value of Es~a~e Subjec~ ~:o Tax (lq)
lines 1~, 15 and/or 16, 17,
Zf an assessment Nas issued previously,
reflect figures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX: 1E. Amoun~ of L/ne 1~, a~ Spousal ra~e
16. Amount( of Line lq ~axable a~ Lineal/Class A ra~a
17. Amoun~ of Line lq a~ Sibling ra~o
18. Aeoun~ of L/ne 1~ ~axable a~ Collar(oral/Class B ra~a
19. Prlnc/>al Tax Due
DISCOUNT
INTEREST/PEN PAID (-)
.00
TAX CREDITS
PAYMENT
DATE
09-08-200q
.00
q,87q .87
18 and 19 ~ill
tlS) .00 x O0 = .00
(~6) q,87q.87 x 0q5: 219.37
(].7) .00 x 12 = . O0
(lB) .00 x 15 : .00
(19)= 219 .$7
RECEIPT
NUMBER
CD00q$60
AMOUNT PAID
219 .$7
219
.00
.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
ZF PAID AFTER DATE XNDXCATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS RE;)UIRED.
ZF TOTAL DUE 1S REFLECTED AS A 'CRED/T' (CR), YOU MAY BE DUE-/'
A REFUND. SEE REVERSE SIDE OF TH/S FORM FOR ZNSTRUCT/ONS.)
RESERVATION:
Estates of decedents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred
in possession ar enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Coaaonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the laaful Class B (collateral) rate on any such future interest,
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADH/N-
ISTRATIVE
CORRECTIONS:
DXSCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S.
Section 91q0).
Detach the top portion of this Notice and submit with your payment to the Register of Rills printed on tho reverse side.
--Make check or money order payable to: REGISTER OF RILLSj AGENT
A refund of a tax credit, which was not requested on the Tax Return, amy be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-151$). Applications are available at the Office
of the Register of Rills, any of the Z5 Revenue District Offices, or by calling the special Z4-hour
ansaering service for forms ordering: 1-800-561-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-5010 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as sheen on this Notice must object within sixty (60) days of receipt of
this Notice by:
--aritten protest to the PA Department of Revenue, Board of Appeals, Dept. 281011, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 17118-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three ($) calendar months after the decedent's death, a five percent (5Z) discount of
the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed on the tuts1 of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of
six (61) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1981 will beer interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1981 through 2004 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ 201 .00054& ~)'~-1991 11Z .000501 ~ 9Z .000247
1985 16Z .000458 1992 9Z .000247 2002 61 .000164
1984 llZ .000501 1993-1994 7Z .000191 2005 52 .000157
1985 152 .000556 1995-1998 92 .000247 2004 42 .000110
1986 101 .000274 1999 7Z .OO019Z
1987 10Z .000274 ZOOO 7Z .000191
--Interest is calculatad as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAXLY TNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. Xf payment is made after tho interest computation date shown on the
Notice, additional interest must be calculated.
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY
UNTIL COMPLETION
STATUS REPORT UNDER RULE 6.12
Name of Decedent: '~ ~ 7~/ d, cJ)~'O Vt5/~
Date of Death: ! - '2 1 ~ O ~
Estate No.: 2.1 ~ ~c'/ ~ Od)O/~
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect
to completion of the administration of the above-captioned estate:
State whether administration of the estate is complete:
Yes i~ No
Date:
If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
(date)
If the answer to No. 1 is yes, state the following:
A. Did the personal representative file a final account with the court?
Yes No t~
B. The separate Orphans' Court No. (if any) for the personal representative's
account is: (Not Applicable in Dauphin County)
C. Did the personal representative state an account informally to the parties in
interest? Yes ~ No
D. Copies of receipts, releases, join&rs and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached
to this report.
(MAH:rmtJAM3)
Signature
Name (Please type or print)
Address i~¢ itl/qAv~(_~q[,,Va ~ )
7 t q T- / o o
Telephone No.
R.W. - 5~
Capacity:
Personal Representative
Counsel for Personal Representative